Carpenter W T, Kirkpatrick B
Maryland Psychiatric Research Center, Baltimore 21228.
Schizophr Bull. 1988;14(4):645-52. doi: 10.1093/schbul/14.4.645.
Research has demonstrated considerable heterogeneity in the long-term course of schizophrenia. In the period preceding the onset of frank psychosis (onset), patients vary relative to the rapidity of onset, the presence or absence of associality, and the presence or absence of semipsychotic symptoms. Following the onset of psychosis (middle course), patients may suffer from episodic or unremitting psychosis, and may or may not exhibit the deficit syndrome. In late adult life (late course), patients vary relative to the presence or absence of an improvement in psychosis and social capability. The usual approach to the study of putative course subtypes is to define a subtype by a number of features; they may include features of more than one epoch. In addition, the course of psychosis has not been distinguished from enduring personality impairments in these subtypes. Another approach to defining putative course subtypes would be based on dichotomizing patients according to the presence or absence of a particular feature of a single epoch. This second approach has important advantages: the availability of larger study populations and a diminished liability for confounding due to the correlates of features other than those under scrutiny.
研究表明，精神分裂症的长期病程存在相当大的异质性。在明显精神病发作（发病）之前的时期，患者在发病速度、是否存在社交障碍以及是否存在半精神病症状方面存在差异。在精神病发作之后（病程中期），患者可能患有发作性或持续性精神病，并且可能表现或不表现出缺陷综合征。在成年后期（病程后期），患者在精神病和社交能力是否改善方面存在差异。研究假定病程亚型的常用方法是通过一些特征来定义一个亚型；这些特征可能包括多个阶段的特征。此外，在这些亚型中，精神病病程与持久的人格障碍并未区分开来。另一种定义假定病程亚型的方法是根据单个阶段的特定特征是否存在将患者二分。第二种方法具有重要优势：可以获得更大的研究群体，并且由于受审查特征以外的其他特征的相关性而导致混淆的可能性降低。
